Using EFA and DAS28, a correlation between the clinical activity of RA and B19 infection was confirmed. These data suggest that EFA is applicable for medico-biological studies.
Background and Objectives: The revascularization strategy for percutaneous coronary intervention (PCI) in patients with multivessel (MV) acute coronary syndrome (ACS) remains controversial. Certain gaps in the evidence are related to the optimal timing of non-culprit lesion revascularization and the utility of instantaneous wave-free ratio (iFR) in the management of MV ACS intervention. The major benefits of iFR utilization in MV ACS patients in one-stage complete revascularization are: (1) the possibility to virtually plan the PCI, both the location and the extension of the necessary stenting to achieve the prespecified final hemodynamic result; (2) the opportunity to validate the final hemodynamic result of the PCI, both in culprit artery and all non-culprit arteries and (3) the value of obliviating the uncomfortable, costly, time consuming and sometimes deleterious effects from Adenosine, as there is no requirement for administration. Thus, iFR use fosters the achievement of physiologically appropriate complete revascularization in MV ACS patients during acute hospitalization. Materials and Methods: This pilot study was aimed to test the feasibility of a randomized trial research protocol as well as to assess patient safety signals of co-registration iFR-guided one-stage complete revascularization compared with that of standard staged angiography-guided PCI in de novo patients with MV ACS. This was a single-center, prospective, randomized, open-label clinical trial consecutively screening patients with ACS for MV disease. The intervention strategy of interest was iFR-guided physiologically complete one-stage revascularization, in which the virtual PCI planning of non-culprit lesions and the intervention itself were performed in one stage directly following treatment of the culprit lesion and other critical stenosis of more than ninety percent. Seventeen patients were recruited and completed the 3-month follow-up. Results: Index PCI duration was significantly longer while the volume of contrast media delivered in index PCI was significantly greater in the iFR-guided group than in the angiography-guided group (119.4 ± 40.7 vs. 47 ± 15.5 min, p = 0.004; and 360 ± 97.9 vs. 192.5 ± 52.8 mL, p = 0.003). There were no significant differences in PCI-related major adverse cardiovascular events (MACE) between the groups during acute hospitalization and at 3-months follow-up. One-stage iFR-guided PCI requires fewer PCI attempts until complete revascularization than does angiography-guided staged PCI. Conclusions: Complete revascularization with the routine use of the virtual planning tool in one-stage iFR-guided PCI is a feasible practical strategy in an everyday Cath lab environment following the protocol designed for the study. No statistically significant safety signals were documented in the number of PCI related MACE during the 3-month follow-up.
Background The role of parvovirus B19 (B19) infection as an initiator of the classic erosive rheumatoid arthritis (RA) is being constantly debated. The main argument against etiological association of B19 with RA is a very small portion of erosive arthritisregistered after acute B19 infection. However B19-associated RA may be developed as a consequence of persistent B19 infection in host’s tissues and a chronic immune activation. Objectives To study a possible association between aggressivity and activity of RA clinical course and presence of B19 infection markers. Methods Serum/plasma and blood samples from 52 RA patients (35 of them with erosive arthritis) and 25 sex and age-matched apparentlyhealthy individuals were studied. The values of rheumatoid factor (RF) and anti-cyclic citrullinated protein antibodies (anti-CCP) were analyzed as markers of RA aggressivity. The disease activity score (DAS), serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were analyzed as disease activity indicators. Virus-specific IgG and IgM class antibodies were detectedusing recomLine Parvovirus B19 IgG and IgM test, the presence of B19 genomic sequences - by B19 VP1 and B19 NS1 nested PCRs. Fisher’s exact test, the independent-samples T test and ANOVA were used in the statistical analyses. Results The serological studies revealed anti-B19 IgG antibodies in 76% (19/25) of healthy individuals and 92.3% (48/52) of RA patients, the specific IgM antibodies werefound in 30.8% (16/52) of RA patients and 8% (2/25) of healthy persons (p=0.042), the presence of B19 DNA was detected in 26.9% (14/52) of RA patients and 12% (3/25) of control group individuals plasma DNA samples. 14 out of 52 RA patients had only virus specific IgG, 12 - IgM and IgG, 5 - IgM± and IgG class antibodies, in another 12 patients - virus-specific antibodies and viremia were revealed, in 5 - viral genomic sequences were detected in the blood cells’ DNA together with other B19 infection markers, but 4 patients were without B19 infection. The markers of active B19 infection (presence of anti-B19 IgM class antibodies and virus DNA in plasma or blood) were observed in 29/52 (55.8%) RA patients versus 4/25 (16.0%) control group individuals (p=0.0012). The indexes of disease activity (CRP and DAS but not ERS) were higher in patients with active B19 infection (IgM antibodies and virus DNA in plasma or blood cells) compare to the patients’ group with virus specific IgG class antibodies (IgG+) only. The mean values of the disease activity indexes in IgG+ group patients were DAS=3.94±0.31, CRP=3.97±0.58 mg/L versus DAS=5.42±0.26 (p<0.001), CRP=12.93±3.22 mg/L in thegroup with virus DNA in plasma or blood cells, and more high DAS=5.52±0.21 (p<0.001), CRP=47.31±9.73 mg/L (p<0.0001) in the IgM+ group patients. In the IgM+ group high indexes of disease aggressivity were observed: RF=267.37±59.64 U/ml and anti-CCP=398.60±120.11 U/ml versus RF=63.19±22.73 U/ml (p=0.006) and anti-CCP=71.22±45.59 U/ml (p=0.023) in the IgG+ group. Conclusions The high frequency ...
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